Childhood Adversity and Adolescent Smartphone Use Across Sexual Orientation and Gender Expression

This cross-sectional study evaluates the associations between adverse childhood experiences and problematic smartphone use among adolescents in China across different sexual orientation and gender expression groups.

This supplemental material has been provided by the authors to give readers additional information about their work.
Gender expression was measured with a validated measure by asking the following question: "A person's appearance, style, dress, or the way they walk or talk may affect how people describe them.How do you think people at school would describe you?" 9 The response options were: "very feminine," "mostly feminine," "somewhat feminine," "equally feminine and masculine," "somewhat masculine," "mostly masculine," and "very masculine."Based on a student's response to this and to the question "What is your sex?" (response options were "female" or "male") Students were categorized from most gender conforming (indicating very feminine female students and very masculine male students) to most gender nonconforming (indicating very masculine female students and very feminine male students) 10 .In this study, because of the limited number of mostly or very masculine female students and the limited number of mostly or very feminine male students, we adopted a 3-level GNC variable based on previous studies, including one of our previous works 11,12 : (1) high GNC (somewhat, mostly, and very masculine female students and somewhat, mostly, and very feminine male students), (2) moderate GNC (equally feminine and masculine female and male students), and (3) low GNC (somewhat, mostly, and very feminine female students and somewhat, mostly, and very masculine male students).

Ethnicity
Ask the participants "if their ethnicity is Han?" and if not, ask them to indicate their  males.Homosexual=male students who describe themselves as romantically attracted to males; female students who describe themselves as romantically attracted to females.Bisexual=students who describe themselves as romantically attracted to both males and females.In this analysis, the variable of sexual orientation was categorized into heterosexual, homosexual, bisexual, and not sure adolescents, and the reference group was heterosexual adolescents.b : Low=Female students who describe themselves as very/mostly/somewhat feminine; male students who describe themselves as very/mostly/somewhat masculine.
Moderate=Students who describe themselves as equally feminine and masculine.High=Female students who describe themselves as very/mostly/somewhat masculine; male students who describe themselves as very/mostly/somewhat feminine.In this analysis, the variable of gender nonconformity was categorized into three groups: low GNC, moderate GNC, and high GNC adolescents.The reference group was low GNC adolescents.

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Zheng X et al.JAMA Network Open.specific ethnicity.Ethnicity was categorized into two groups: Han and ethnic minority, with the Han ethnicity representing the predominant group in China numerically.eFigure.Directed Acyclic Graph (DAG) for Adverse Childhood Experiences (ACEs), Problematic Smartphone Use (PSU), and Other Covariates Across Sexual Orientation and Gender Expression Groups [The minimally sufficient adjustment set was determined using the DAGitty software.The simplified //www.dagitty.net/dags.html#)].
Directed Acyclic Graph (DAG) for Adverse Childhood Experiences (ACEs), Problematic Smartphone Use (PSU), and Other Covariates Across Sexual Orientation and Gender Expression Groups eTable 1. Characteristics of Study Participants Across Gender Expressions eTable 2. Characteristics of the Included and Excluded Participants eTable 3. Prevalence Estimates of PSU and 95% CIs by Study Characteristics eTable 4. Categorized ACEs Across Sexual Orientation and Gender Expressions eTable 5. Interactions Between ACE and Sexual Orientation/Gender Expression on PSU eReferences

Characteristics of study participants across gender expressions (continued)
Missing data: 681 for ethnicity, 708 for place of residence, 487 for PSU, 216 for sexual abuse, 219 for physical abuse, 248 for emotional abuse, 325 for physical neglect, and 328 for emotional neglect.2929 for parental separation or divorce, 2939 for household criminality, 2933 for household domestic violence, 2938 for household mental illness, 2938 for household substance abuse, 2937 for family financial problems, 2938 for death of parents, 2932 for witness of community violence, 2936 for and sex discrimination, 3299 for ACEs score, 1514 for gender expression.

Characteristics of the Included and Excluded Participants
The included group consisted of participants who had complete data on demographics, PSU, ACEs, sexual orientation, and gender expression variables.Missing data of excluded participants: 682 for ethnicity, 707 for place of residence, 375 for abuse, 393 for neglect, and 2942 for household dysfunction.

Prevalence estimates of PSU and 95% confidence intervals (CIs) by study characteristics (continued)
: PSU was measured by the SAS-SV scores, ranging from 10 to 60; male students with SAS-SV scores ≥ 31 and female students with SAS-SV scores ≥ 33 were classified as the PSU group.a : Students who reported any of those abuse (sexual abuse, physical abuse, and emotional abuse) were included in the abuse reported group, and students who reported any of those neglect (physical neglect and emotional neglect) were included in the neglect reported group, students who reported any of those household dysfunction (parental separation or divorce, household criminality, household domestic violence, household mental illness, household substance abuse, family financial problems, death of parent, witness of community violence, and sex discrimination) was included into the household dysfunction reported group.

Sex discrimination (yes vs. no) Sex discrimination (yes vs. no)
* : Models were adjusted for age, sex, ethnicity, and place of residence.

eTable 5. Interactions Between ACE and Sexual Orientation/Gender Expression on PSU a
: PSU, problematic smartphone use; ACEs, adverse childhood experiences; PR, prevalence ratio; APR, adjusted prevalence ratio; 95% CI, 95% confidence interval.Models showed good model fit, with the Wald test reporting P<0.001 and the Pearson goodness-of-fit test reporting P>0.10.: PSU was measured by the SAS-SV scores, ranging from 10 to 60; male students with SAS-SV scores ≥ 31 and female students with SAS-SV scores ≥ 33 were classified as the PSU group.Model 1 was a crude model.Model 2 was adjusted for age, sex, ethnicity, and place of residence.